Abstract

BACKGROUND: To alleviate stinging pain in the skin entry area and visceral discomfort in patients who are undergoing ESWL.

OBJECTIVES: This study was designed to investigate the effectiveness of the EMLA cream in combination with remifentanil patient-controlled analgesia (PCA) in patients undergoing ESWL treatment.

PATIENTS AND METHODS: Sixty patients were divided into two double-blind randomized groups. Those in the first group were administered 3-5mm of EMLA 5% cream on a marked area; the second group received, as a placebo, a cream with no analgesic effect in the same amount. All patients were administered a remifentanil bolus with a PCA device. Arterial blood pressure, oxygen saturation, and respiratory rate were recorded throughout the procedure; postoperative side effects, agitation, and respiratory depression were measured after. Visual Analogue Scale (VAS) scores were taken preoperatively, perioperatively, directly postoperatively, and 60 minutes subsequent to finishing the procedure.

RESULTS: There were no statistically significant differences in the frequency of PCA demands and delivered boluses or among perioperative VAS. No significant side effects were noted. Patient satisfaction was recorded high in both groups.

Comments
1

The authors studied the possible effect of EMLA cream application as a complement to remifentanil during SWL. The conclusion was that EMLA did not offer any advantage. The reason for that is probably that the major pain component during SWL does not come from the skin but is visceral. My own experience is that with a low-power SWL some positive effect can be noted, but this effect disappears when a higher shockwave power, necessary for stone disintegration, is used.

The authors studied the possible effect of EMLA cream application as a complement to remifentanil during SWL. The conclusion was that EMLA did not offer any advantage. The reason for that is probably that the major pain component during SWL does not come from the skin but is visceral. My own experience is that with a low-power SWL some positive effect can be noted, but this effect disappears when a higher shockwave power, necessary for stone disintegration, is used.
Hans-Göran Tiselius